HIV Self Testing to Empower Prevention Choices in Sex Workers

艾滋病毒自我检测可增强性工作者的预防选择

• 批准号: 9919021
• 负责人: Andrew Mujugira
• 金额: $ 10.34万
• 依托单位: INFECTIOUS DISEASES INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-22 至 2022-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9919021
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Address; Adherence; Adopted; Adult; African; Age; Anal Sex; Anti-Retroviral Agents; Attitude to Health; Award; Behavior Therapy; Behavior monitoring; Behavioral Sciences; Blood; Car Phone; Caring; Client; Clinic; Clinical Trials; Cohort Studies; Communicable Diseases; Data; Data Collection; Decision Making; Detection; Diagnosis; Disclosure; Discrimination; Effectiveness; Epidemic; Epidemiology; Evaluation; Face; Female; Foundations; Frequencies; Friends; Fright; General Population; Generations; Goals; HIV; HIV Infections; HIV Seroprevalence; Health; Health Personnel; Human immunodeficiency virus test; Incidence; Income; Individual; Influentials; Institutes; Intervention; Interview; Kenya; Measures; Mediation; Medicine; Mentors; Methods; Monitor; Oral; Patient Self-Report; Pattern; Perception; Pharmaceutical Preparations; Population; Positioning Attribute; Postdoctoral Fellow; Prevention; Preventive Intervention; Prostitution; Questionnaires; Randomized; Reporting; Research; Research Personnel; Research Training; Risk; Sampling; Self Efficacy; Services; Sex Behavior; Sexual Partners; Sexually Transmitted Diseases; Solid; Spottings; Structure; Surveys; Technology; Telephone; Tenofovir; Test Result; Testing; Time; Training; Uganda; Unsafe Sex; Use Effectiveness; Vagina; Wireless Technology; Work; Workplace; Writing; base; behavior change; clinical research site; condoms; empowered; empowerment; evidence base; experience; female sex worker; global health; high risk; high risk men; high risk sexual behavior; improved; innovation; interest; male; mobile computing; multidisciplinary; new technology; novel strategies; pre-exposure prophylaxis; prevent; prevention service; primary outcome; protective behavior; randomized trial; reproductive; sex; sexual risk behavior; skills; social; social stigma; standard of care; tool; transgender; transmission process; treatment arm; uptake

PROJECT SUMMARY/ABSTRACT The overall goal of the proposed K43 Emerging Global Leader Award is to support Dr. Andrew Mujugira’s research training to develop as an independent global health HIV researcher. Dr. Mujugira is currently a postdoctoral fellow at the Infectious Disease Institute in Kampala, Uganda. Conducting the proposed studies in this application will facilitate his training goals to: 1) develop a solid foundation in behavioral science; 2) gain expertise in mobile technologies for behavior monitoring and intervention; and 3) acquire qualitative data collection, analysis and writing skills. This proposal builds on the unique skills he already has in clinical trials, epidemiology and medicine while leveraging a multidisciplinary team of mentors to ultimately become a productive and influential independent investigator focused on HIV prevention in key populations. The research goal of this proposal is to conduct a rigorous proof-of-concept evaluation to test if HIV self-testing (compared to clinic-based testing) motivates PrEP uptake and adherence, and empowers effective prevention decision making in sex workers. Transgender, male, and female sex workers are 49, 21 and 14 times as likely to be HIV-infected as other adults in the general population. In Uganda, sex workers have high HIV seroprevalence (35-37%) and account for 10% of new HIV infections. Two robust, evidence-based, self-controlled HIV prevention tools are available -- HIV self-testing (HIVST) and antiretroviral pre-exposure prophylaxis (PrEP) -- but these are not currently well utilized among sex workers. HIVST and PrEP are complementary tools that could be combined to build self-efficacy and empowerment, increase PrEP adherence and reduce sexual risk behaviors. However, research is needed to show how combination HIVST and PrEP may have a synergistic impact on uptake and use of each prevention intervention. To address these questions, Dr. Mujugira will conduct a randomized trial among sex workers initiating PrEP in Uganda to test if HIV self-testing increases PrEP adherence among HIV- uninfected sex workers (Aim 1), decreases sexual risk behavior in sex workers taking PrEP (Aim 2), and influences prevention choices among sex workers and their partners (Aim 3). He will use novel technologies (real-time electronic monitoring with Wisepill technology and mobile phone surveys) to characterize patterns of PrEP adherence, and assess how use of HIVST and PrEP aligns with sexual risk behaviors. Additionally, he will conduct in-depth qualitative interviews to explore the mechanisms through which combined HIVST and PrEP delivery may be synergistic and empowering. This study will be the first to jointly evaluate HIVST and PrEP in sex workers. Dr. Mujugira’s research goals correspond with his training goals, and by the completion of this award, he will be in an excellent position to submit an R01 application that furthers the research agenda in HIV prevention.

项目概要/摘要 拟议的 K43 全球新兴领袖奖的总体目标是支持 Andrew Mujugira 博士的 研究培训，培养成为一名独立的全球健康艾滋病毒研究人员。 Mujugira 博士目前是一名 乌干达坎帕拉传染病研究所博士后研究员。进行拟议的研究 该应用程序将促进他的培训目标：1）在行为科学方面打下坚实的基础； 2）增益 行为监测和干预移动技术方面的专业知识； 3）获取定性数据 收集、分析和写作能力。该提案建立在他在临床试验中已有的独特技能的基础上， 流行病学和医学，同时利用多学科导师团队，最终成为 富有成效且有影响力的独立调查员，专注于重点人群的艾滋病毒预防。研究 该提案的目标是进行严格的概念验证评估，以测试艾滋病毒自检（与 基于临床的检测）促进 PrEP 的采用和坚持，并促进有效的预防决策 在性工作者中。跨性别、男性和女性性工作者感染艾滋病毒的可能性分别是其 49 倍、21 倍和 14 倍 和一般人群中的其他成年人一样。在乌干达，性工作者的艾滋病毒血清阳性率很高（35-37%） 占新发艾滋病毒感染者的 10%。两种强大的、基于证据的、自我控制的艾滋病毒预防工具是 可用——艾滋病毒自检（HIVST）和抗逆转录病毒暴露前预防（PrEP）——但这些都不是 目前在性工作者中得到了很好的利用。 HIVST 和 PrEP 是互补工具，可以结合起来 建立自我效能和赋权，提高 PrEP 依从性并减少危险性行为。然而， 需要研究来证明 HIVST 和 PrEP 的结合如何对吸收和预防产生协同影响。 使用每项预防干预措施。为了解决这些问题，Mujugira 博士将进行一项随机试验 在乌干达开展 PrEP 的性工作者中进行了一项调查，以测试 HIV 自我检测是否可以提高 HIV 人群中 PrEP 的依从性 未受感染的性工作者（目标 1），减少服用 PrEP 的性工作者的性危险行为（目标 2），以及 影响性工作者及其伴侣的预防选择（目标 3）。他将使用新技术 （利用 Wisepill 技术和手机调查进行实时电子监控）来表征 PrEP 依从性，并评估 HIVST 和 PrEP 的使用如何与性风险行为保持一致。此外，他还将 进行深入的定性访谈，探讨 HIVST 和 PrEP 相结合的机制 交付可能是协同和赋权的。这项研究将是第一个联合评估 HIVST 和 PrEP 的研究 性工作者。 Mujugira 博士的研究目标与其培训目标相符，并且通过完成这项工作 获奖后，他将能够提交 R01 申请，进一步推进艾滋病毒研究议程 预防。